External Site Reviews

MSHN has external quality reviews completed by the Michigan Department of Health and Human Services (MDHHS) and the Health Services Advisory Group (HSAG).  To comply with requirements of the Center for Medicare and Medicaid Services (CMS), MDHHS completes a review of the PIHPs for services provided under the Habilitation Supports Waiver (HSW) and Substance Use Services.  Also to comply with CMS requirements, MDHHS contracts with HSAG to measure and report on performance to assess the quality and appropriateness of care and services provided to members. HSAG completes three separate reviews:  Performance Measure Validation (PMV), Performance Improvement Project (PIP) and the Compliance Monitoring review.  

HSAG Performance Measure Validation (PMV) Review

The purpose of Performance Measure Validation (PMV) review is to assess the accuracy of performance indicators reported by the PIHPs and to determine the extent to which performance indicators reported by the PIHPs follow state specifications and reporting requirements. 

HSAG Compliance Monitoring Review

The purpose of Compliance Monitoring review is to determine the PIHP’s compliance with the standards set forth in 42 CFR §438—Managed Care Subpart D and the quality assessment and performance improvement requirements described in 42 CFR §438.330. 

HSAG Performance Improvement Project

The purpose of the Performance Improvement Project review  is to comply with the MDHHS requirement that the PIHP conduct and submit performance improvement projects (PIPs) annually to comply with the Balanced Budget Act of 1997 (BBA), which states that the quality of health care delivered to Medicaid enrollees in PIHPs must be tracked, analyzed, and reported annually.  PIPs provide a structured method of assessing and improving the processes, and thereby the outcomes, of care for the population that a PIHP serves.

MDHHS Waiver Reviews

The Michigan Department of Health and Human Services (MDHHS) conducted a follow up desk review for our region from February 17, 2021 through April 30, 2021.  The purpose was to review the implementation status and effectiveness of the corrective action plan, completed for the full review in FY2020, for the Habilitation Supports Waiver (HSW), the Waiver for Children with Serious Emotional Disturbance (SEDW) and the Children’s Waiver Program (CWP).      

The MDHHS site review staff assessed whether the actions taken by the PIHP were effective in correcting the findings noted during the initial site review. The review staff found the actions taken by the PIHP were effective in correcting the findings noted during the initial site review.

 

MDHHS Substance Use Services Review

MSHN received full compliance on all standards reviewed by the Michigan Department of Health and Human Services (MDHHS) for compliance with the Substance Use Agreement with the Centers for Medicare and Medicaid services during FY2020. There was no follow up review required during FY2021.